Nursing Assignment Case Study Analysis 2022

Running head: NURSING ASSIGNMENT
CASE STUDY ANALYSIS
Name of the student
Name of the university
Author note

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Introduction
Pathophysiological analysis is the process discipline that focuses on the primary
reason due to which patients suffer from their disease conditions. This paper discusses about
the case study of Mrs. Helena Jones (48), who has a long history of multiple sclerosis (13
years) and recently has been diagnosed with the type 2 diabetes mellitus as co-morbidity.
This paper therefore, would discuss about the pathophysiology of both of these health
complications for Mrs. Helena Jones and then with discussion of the first sign and symptom
common in both of her health complication, three nursing interventions would be determined.
Part 1
Pathophysiology of multiple sclerosis
While discussing the pathophysiology of Multiple Sclerosis (MS), the elusive nature
of the causes should be discussed as this disease is considered to be an Inflammatory
Demyelinating Disease (IDD) or idiopathic disorder (Passos, Sato, Becker & Fujihara, 2016).
As per Manjaly et al. (2019), the presence of this health complication among patients is
determined due to the presence of plaques in the inflammatory demyelination of the central
nervous system. When the active immune cells from the patient’s body invades the central
nervous system, then it leads to an inflammatory reaction and the accumulation of plaque is
considered to be the reason of myelin destruction. As per Finke et al. (2015), there are
multiple reasons due to which these plaques form lesions in the CNS. These lesions present
multiple aspects of immunological and pathological reactions in patient’s body. These influx
of immunological cells are comprised of t cells, major histocompatibility class (MHC) II, and
lymphocytes and these are known to be involved in the stripping of axons within CNS.
Further, both the stripping of axon and damages caused by plaque formation leads to the
hypertrophic astrocytes that leads to the chronic development of the condition (Passos, Sato,

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Becker& Fujihara, 2016). Hence, from this above-mentioned analysis it could be observed
that the combination of immunological and pathological conditions leads to this critical
health condition in patients.
Pathophysiology of type 2 Diabetes Mellitus
The analysis of pathophysiology related to type 2 diabetes mellitus is complicated in
multiple aspects as various conditions associated with patient’s physiological complications
and lifestyle could lead to development of this disease condition. These reasons include
deficiency of insulin, insulin resistance, further due to the genetic as well as environmental
influence the risk factor related to diabetes type 2 increases (Kautzky-Willer, Harreiter&
Pacini, 2016). As per Zheng, Ley and Hu (2018), majority of the patient are affected with
diabetes type 2 are associated with lack of physical activity and insulin resistance. Due to
genetic modification, the insulin secretion gets hampered and then with the excess secretion
of glucagon, a condition namely hyperglycaemia occurs. During glucose stimulation, as per
Zaccardi, Webb, Yates and Davies (2018), the beta cell dysfunction leads to the insulin
secretion dysfunction and then leads to the glucose intolerance in type 2 diabetes. For the
proper function of the beta cells or the proper secretion of beta cells, the cells require glucose
to be transported to the cell that is conducted by the glucose transporter 2. As per autzky-
Willer, Harreiter and Pacini (2016), this transporter and its functioning both are affected due
to the genetic modification and hence the onset of disease condition is observed. Therefore,
this is pathophysiology of type 2 diabetes which is observed in patients.
First sign or symptom common both in MS and T2DM
The first sign or symptom which could be observed in Mrs. Helena Jones is her
physical weakness and numbness in legs and hips. As per Petzold et al. (2016), this is the
symptom which could be observed in both type 2 diabetes mellitus and multiple sclerosis. To

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understand the common causes of numbness in both MS and T2DM, the pathophysiological;
aspects of both the diseases and associated numbness should be assessed. As per Faissner et
al. (2016), there are four type of numbness that are observed among patients, such as the
paresthesia, dysesthesia, hyperpathia and anesthesia, within which, the first three types are
commonly observed in patients suffering from MS. As perValet, Stoquart, Glibert,
Hakizimana and Lejeune (2016), due to severe demyelination in the central nervous system
including the brain and spinal cord, as well as the nerve fibers that helps to collect signals
from the body to central nervous system are affected. This disturbance in the sensory fibers
increases with time and hence, the patients suffer from mild to severe numbness in their
body. On the other hand, numbness in T2DM is occurred due to the hypertension condition
that ultimately leads to diabetic neuropathy and all the nerves that transfer signals from
central nervous system to the hands and feet are damaged (Pavate, Nerurkar, Ansari&
Bansode, 2019). Therefore, this is the reason due to which patients that are diagnosed with
T2DM are diagnosed with tingling sensation in toes, fingers, feet and hands. This is the
reason, this is a symptom in case of MS and T2DM (Kautzky-Willer, Harreiter & Pacini,
2016).
Second sign or symptom common both in MS and T2DM
The second sign of both MS and T2DM that could be identified for the health
complication of Mrs. Helena Jones is her difficulties of vision due to which she wears
glasses. As per Dayer, Abdollahzadeh, Nadery& Nasab (2016), vision related complication is
one of the crucial symptom of patients with MS. These complications are associated with
diplopia or double vision, optic neuritis, blurred vision, and improper or uncontrolled eye
movement that finally leads to complete loss of vision. The pathophysiology of this health
complication could be understood from the aspect that due to plaque formation and lesion
generation in the CNS of patient, due to which the optic nerves are damaged. Further, due to

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pathological or immunological inflammation of the nerves that causes accurate vision,
patients also observed diplopia. Further, these lesions and plaque formation also weakens the
muscle movement due to which uncontrolled eye movement is observed among the patients.
Further, as per Wicki, Hanson and Schippling (2018), impaired vision is also a primary
complication of T2DM patients. As per Dayer,Abdollahzadeh, Nadery and Nasab (2016), due
to high blood sugar levels, the cornea gets swollen and hence affects the ability if cleared
vision. However, this condition is not permanent and with proper medication, this
complication could be relieved in 6 weeks. However, in several researches, it has been found
that due to diabetes, the retina of patients gets affected that leads to irreversible eye
complication (Dayer, Abdollahzadeh, Nadery & Nasab, 2016). The light sensitive tissues in
the retina are affected due to high blood sugar level and due to the damage of these blood
vessels in retina, patients may suffer from irreversible eye sight loss.
Nursing Intervention
From the case study it is evident that Mrs Jones was suffering from the condition of
type 2 diabetes mellitus and multiple sclerosis and required a detailed care and attention form
the healthcare professionals and the registered nurses. Based on the health condition, the
nurses will provide an effective nursing intervention that will aim to improve her health
condition and educate her on the preventive strategies that must be adopted by the patient to
recover from illness as soon as possible (Marrie, 2017).
The patient had developed severe weakness due to the condition multiple sclerosis
and she could not walk properly and had weakness in her left leg and foot, therefore effective
nursing intervention was required to address the issue of severe weakness as this would
increases due to her type 2 diabetes. The initial nursing intervention is to determine the
requirements for walking supports such as wheelchairs, walkers or braces that will
review the safety consideration of the patient. The nursing intervention of mobility

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associated with physical therapy will help the patient in decreasing the feeling of fatigue or
weakness and also enhance the sense of independence, safety and comfort in the patient
(McCarberg et al., 2017). The use of walking stick can be risky for the patient as she is
feeling extremely weak and hence, the nurse must provide a wheel chair for the patient so
that she can mobilise within the house and reduce the feel of helplessness among her.
The inconsistency of urine is one of the major symptoms associated due to both
multiple sclerosis and type 2 diabetes and hence the patient required an effective intervention
that will monitor the inconsistency in her urine and provide strategy that will aim to reduce
the issue of inconsistent urine. The nurse will encourage the patient to consume adequate
amount of fluid and avoid the consumption of caffeine or aspartame especially during the late
evening as it will increase the issue of inconsistent urine. The pharmacological intervention
was also prescribed to the patient by the nurse that will assist in maintaining the urine
inconsistency in the patient and control the frequent urge of the patient to urinate that will
include Ditropan XL, Enablex or Sanctura XR. The consumption of medicine will allow the
patient to reduce her mobility and take appropriate rest that will in turn enhance her overall
health condition.The nurse will also educate the patient regarding the benefits of consuming
vitamin C or cranberry juice that will help her in reducing the issue of urinary inconsistency
(Halper et al., 2016). The intervention of sufficient hydration will help the patient in
enhanced urine output and also assist her in reducing the risk of infection. The nurse will also
monitor the medication of the patient to reduce the risk of bladder irritation and avoid any
such mediation that can cause bladder dysfunction and result in inconsistent urine.
From the case study it is evident that the visual activity of the patient was getting
affected as the patient was losing her right eye sight, which is again considered as the major
symptom of both multiple sclerosis and type 2 diabetes mellitus. Since the patient was
suffering from multiple sclerosis form past 13 years, the condition had badly affected her eye

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sight and due to the high blood sugar level, the eye sight of the patient will get majorly
affected and she might even lose her eye-sight (Bitirgen et al., 2017). Further, due to her
increasing inability, it was found that she should be provided with services of allied
health professional so that they could help the patient with her incontinence, her
hygiene and cleanliness (Bowley, Short & Furmage, 2016). Hence, the final nursing
intervention that should be included in the health condition of Mrs. Helena, is to include
continence nursing advisor in her healthcare process so that the they also can the
aspects due to which, she is suffering from (SurI & Das, 2016). This involvement of
allied healthcare professional will help the nurse to identify if the patient requires
corrective therapy that will help her in improving the eye sight and also provide care
and support to the patient that will enable her to effectively perform the daily activities
of life (Cuevas et al., 2019).
Conclusion
From the study it can be concluded that the patient was suffering from a long-term
health issue of multiple sclerosis and had been recently diagnosed with type 2 diabetes
mellitus that were majorly affecting her health condition. The three nursing intervention with
1 allied helath professional referral were highlighted in the study that included intervention
for weakness or fatigue, urine inconsistency and reduced eye-sight, which will eventually
help the patient in slowly overcoming from her bad health condition.

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